Catching Up: The Post- Depot Lupron FET

Hi!

Sorry it's been a while. Life has been absolutely nuts.

Here is how things went down for this long-awaited transfer, 7 months in the making.

Like planned, I had my last DL injection on 5/1. Per Dr. KKs protocol, I started 10mg Prednisone daily on 5/3 (21 days before CD1, or the first day of FET meds). So far, so good.

I was instructed to send in blood work two weeks later. This involved some pretty easy blood panels, like metabolic panels and CBC, but also the Kwak-Kim specific panels like NK cells and Cytokines. So, they needed to be mailed to the Rosalind Franklin University lab. To do this, I called local hospitals to see if they would do what's called a "courtesy draw" for me, where I provide the orders and the vials of blood (which KKs office mails me), they draw the blood and then they mail it for me. Dr KKs office also provides me with a FedEx clinical pak to package the vials and all I have to do is print an overnight shipping label. The phlebotomist then puts my pack o' blood with their FedEx pickup and it arrives in Chicago the next day.

My first results showed that my cytokines, which had been slightly elevated at 35 (normal is less than 30.6) were now very elevated at around 49. My NKs, which had been 4.5%, were now around 16% (anything above 15% is elevated). This led me to the great IVIG debate, which I will write about later.

From there, my Prednisone was increased to 15mg daily. Fine. Other than that, I just kept taking my Synthroid.

On 5/23, I had my baseline. They had a hard time "finding my lining" which I guess was to be expected coming off of the DL - after all, it was supposed to strip my lining and bring back a new, shinier version.

From there, I started my FET prep - this involved 2mg Estradiol three times daily, Augmentin to make sure I didn't have an infection, and Letrozole (Femara) once daily. So far, so good.

On 5/28 (CD 6 of meds), I began a daily lovenox injection (40mg) per Dr. KK for my poor uterine blood flow.

On 5/31, my husband surprised me with a puppy!! Chaos ensues :-)

On 6/2, I flew out to Chicago for a Friday 6/3 appointment at Dr. KKs office to check my uterine blood flow, run some blood levels and meet with Michell, the NP, regarding my plan going forward. I had been super anxious that whole week because I decided not to do IVIG despite having it covered by insurance, but was happy to find out that my uterine blood flow was awesome, my lining looked amazing (in fact, Michelle said it was rare that they see a lining looking this good!), and while my NKs had gone up slightly to 17%, my Cytokines were way down at around 36 I think. I was super excited!!! I was officially cleared to start Progesterone per my RE the next day.

My transfer was scheduled for the 6th day of Prednsone on Thursday 6/9. I scheduled pre/post acupuncture on transfer day and we headed to see Dr. Wang. Luckily, both embryos thawed and continued to expand! I didn't ask about grading because honestly, it wasn't going to matter. Good embryos don't always implant and crappy embryos sometimes make babies.

I was also instructed to stop lovenox 24 hours before transfer and begin it 12 hours after, and starte 200mg prometrium twice daily beginning 48 hours after transfer.

I had a really challenging TWW. My chemical in October had produced pinching sensations and cramps and slight nausea. This time, I didn't feel much of that - some twinges here and there, and some slight dizziness towards beta, but that was it. I always go beta or bust.

At 8dp5dt, I had my first beta. I was a nervous wreck all day and had them call my husband. After a delay in getting the beta (thanks, Quest), it came back at 78! I was elated....and also ridiculously anxious! Beta at 12dp5dt came back at 634 and today, at 14dp5dt came back at 1945! Holy crap!

My symptoms come and go...anything from twinges to cramping to back aching to very very slight nausea. I'm praying that on Monday, my next beta (per Dr KK, who wants betas up until you see a HB), keeps heading in the right direction!

Well, its been a while...Depot Lupron update...

     Hey there. I have been pretty MIA for the last couple of months. I would love to say that it's been because I've been traveling the world, or [insert super fun thing here], but I haven't. I have been working, going to my clinical rotations, teaching and doing homework for class. Boo. Oh yea, I've also been in a menopausal state, so that's been pretty awesome.

My life has basically been like this:

Depot Lupron hasn't been that bad for me...luckily. The list of side effects would make your head spin...blood in your stool, muscle pains, bone pain, etc. I've just been hot flashing like hell. I would say I get about 1 an hour...sometimes more or less...it's like a furnace is lit in my body. My legs and arms heat up at rapid speed...then it reaches my face and I start to sweat. It's sexy, trust me.

The hot flashes and I were getting along swell until they fucked with my sleep. I'm a great sleeper usually. Despite being anxious and anal retentive, I can fall asleep on a dime. Once the hot flashes came to town, it's been a never-ending cycle  of waking up screaming hot...remove blankets...wake up freezing...put blankets back on...wake up because I am screaming hot again, rinse, wash, repeat.

Needless to say, wearing layers has been my friend.

My brave husband administered my last injection. I'm not sure if I mentioned this before, but the needle is 2" long and made for someone that you would see on TLCs "My 600lb Life," So as of last weekend, there are no more Depot Lupron injections in my foreseeable future which is beyond exciting. I'm ready to have some estrogen back in my life!



The Stratification of IVF

     A couple of weeks ago I was perusing the interwebz for some infertility blogs and came across something that made me particularly stabby. A blogger (I can't remember who or else I would totally call her out) waxed poetic about how painful infertility has been for her. I totally empathized. In fact, I applauded her candor. She spoke about how she was jealous of pregnant friends, the pain of being the odd woman out, and the desperation she felt. She even went so far as to admit that she sometimes wished her friends would miscarry. It's a horrifying thought, but I applauded her bravery in stating that as I think many of us have had those same thoughts - not because we want anything bad to happen, but because misery loves company and sometimes it's satisfying to see someone else struggle so you aren't the only one. I gave her credit for her openness.

     She totally had me at 'hello.' until I saw that that bitch got knocked up her first fucking cycle of IVF. What the EVERLOVING FUCK does she know about pain?! Hopelessness? Desperation?

     In my opinion - not a damn thing.

     She posted that blog entry a couple of years ago, so I immediately clicked to her home page to get the latest updates. And guess what?! She was pregnant AGAIN on her second cycle. Oh bitch please.

     She knows nothing about the pain of infertility because she hasn't had a failed cycle. Hell, she hasn't had multiple failed cycles. Until you get to that point, you don't really know the horror of infertility. I'm not trying to be a bitch, and I'm certainly not trying to play the pain Olympics because that doesn't get anyone anywhere, but still.

     I've come to realize that for some, IVF is the Golden Ticket. It works all the time, 100% of the time. For others, IVF is the beginning of another long, painful road. And in that realization, I've begun to understand that the pain of infertility is doled out via a stratification system. We can all agree that it sucks badly to get to the point of needing IVF, but I hope we can also agree that it sucks even worse to need three, four, five or more cycles to have a baby compared to those who need one.

     What made this particular blogger worse, is that not only has she gotten knocked the fuck up twice in two transfers, but she has enough frozen embryos left over to start a small country. Fuck her. Try being on IVF #3 with fewer embryos to my name over three cycles than she got in her one damn shot.

     I'm not trying to minimize anyone's pain, I'm just trying to show that it is different, and likely more painful to be walking down my path. I've also come to realize that people who get pregnant on their first cycle of IVF tend to make me angrier than the "normies" who get pregnant the good ol' fashioned way. I think its because I feel so far removed from the normal procreators that their fertility doesn't offend me as much anymore (unless they make stupid comments about infertility, in which case they get a swift mental punch in the throat from me), yet those doing IVF are on a more even playing field than me and their success just highlights my failures even amongst the infertiles. And if you got pregnant by IUI? Good gracious you are pretty much fertile in my mind.

     I was so angry reading that post. I almost felt as if she had no right to feel what she was feeling because she ended up getting what she wanted, and getting it easily. Yet here I am, far deeper down the shit hole than she will ever be, and I haven't gotten my happy ending, and quite frankly, strongly doubt I ever will.

     I know I'm inappropriately minimizing the feelings she had that prompted her to write that blog entry, but for that I am not sorry. She got her happy ending. Now where is mine?

IVF #3: The Conclusion

    
     It was the best of time, it was the worst of times. Yes, my latest IVF cycle can be paralleled with the timeless classic, A Tale of Two Cities. Somehow, some way, this cycle managed to be my worst and best.

     To get straight to the good stuff, on Propofol Day egg retrieval day, we retrieved 12 eggs (!!!) but only fucking 5 were mature. I knew this. I had predicted this shit. My estrogen on the day of trigger was 3100+, which was by FAR my highest yet, but, having been around the block too many times, I knew better than to get excited. Highest highs followed by the lowest lows. That is all IVF is to me.

    Aside from the 5 mature, it looked as if a few more may mature in the lab. Thankfully, two more did. That brought our total to 7. Seven. This is the same number of eggs retrieved for IVF #1 and 2! My ovaries are pre-set apparently.

   The Holy Grail of this cycle came in the form of ICSI. This is the first time we did it and 6 of our 7 eggs fertilized! All 6 were still cookin' by day 3, albeit 4 were good and 2 were crapping out. We decided to press on to blast. That was terrifying! Three were blasts on day 5, and one was able to be frozen that day, with the other two frozen on day 6.

   Now that I am a few weeks out from stims, in my non-hormonal state, I'm thrilled with this cycle. Three blasts!! 3!!! We have never, ever had a blast before! Yet, in my drug-induced stupor I was a mess. It was so hard for me to reconcile that we had 12 eggs but not all 12 were mature. And I was frustrated with our low blast rate, even though it is an absolutely normal and expected number. I was ungrateful, and hormonal, and bitter. Truthfully, I was having a hard time with the reality that I won't ever make it rain eggs. I won't ever be the girl who gets 25 eggs and 19 embryos and winds up with 10 frosties. And I hate that. I was also feeling a ton of pressure to get many embryos because this cycle was to be followed with depot lupron for three months for my wonky endometrium, after which, I may not stim as well for a while.

   On day 6 after retrieval, I got an e-mail from Dr. Wang and he told me the second blast had been frozen but we still had to wait on the third, which, without some growth, wouldn't make the blast cut. I lost my shit. I wrote a long and angry e-mail (not anger directed at him) and he immediately called me. This is why I love him and he's the best ever. He spent thirty minutes talking me off the ledge and, telling me that my cycle went just as expected, explaining why he really felt that depot lupron is the right choice for me and giving me some hope. He made me feel so much better, and I was able to begin to realize how wonderful this cycle went.

    We all agreed not to test the embryos at this juncture. I'm praying that we have at least one baby in there. Please, oh please. It's time. It really is. I hope the HGH did it's job and we have some excellent quality pre-babies in there.

    As for now, I'm slowly settling into a menopausal state and trying to enjoy a well-deserved break from infertility treatments. Hopefully I can take some time to decompress, relax, focus on school and try to get back into shape for a short period of time before my body is (hopefully!) ruined by a baby.
   

My Depot Lupron Conundrum

     I don't want to do 3 months of Depot Lupron injections. There, I said it. I wish the decision was that simple. Today is the one day of the week that I decided to relax and do absolutely nothing. No homework, no housecleaning..I'm refusing to even walk the dog today. So, naturally, because I always need something to occupy my mind and elicit some sort of anxiety, I decided to focus on my upcoming Depot Lupron injections.

     To catch you up, Dr. Wang at SIRM CT recommended that I have the Endometrial Function Test (EFT) performed. You can read more about that here. My results showed that I had a high level of "Glandular Developmental Arrest," or GDA. Basically, this is corrected with three months of Depot Lupron injections.

    This is really fucking bad for several reasons. 1) Apparently Depot Lupron has been pulled from the market in several other countries because of the severity of its side effects. And we aren't talking just about the fact this it puts you into menopause. I mean things like cancer, chronic bone diseases, etc. Sounds fan-fucking-tastic. Of course there are many, many women who are just fine, but still. I don't exactly fall on the upside of odds as evidenced by my current bullshit situation.

    Second, we had our chemical in November. In December I didn't ovulate. In January I did the EFT. This month I cycled and for the next three months I'll be sticking myself with the menopause juice. In total, 6 months on the fucking bench. It's really horrifying to think that I will turn 33 in September. We started trying when I was 30. We still don't have a baby.

     This leads me to my major issue: I kind of want to try on our own for several months. Because of an underlying metabolic disorder, we sought treatment after 6 months of trying. That was fortuitous because I had Celiac and the septum. However, between all of the testing and cycling, we've only managed to try on our own for a total of 10 months. Only 1 month of which was after my big issues were solved. I kind of feel like we could have stuck it out longer. Plus, I am sick of feeling like I am spinning my wheels. The EFT and subsequent treatment is controversial at best. Am I doing the right thing by putting everything on hold for three months? Would I be doing the right thing by trying on our own? Should we do an FET with the embryos from this cycle (that are hopefully still growing) and implement Dr. KKs plan and see how it goes? Will I regret it if it is a BFN or winds up in another chemical? I hate not knowing the right path to take.

    To make matters worse, there is next to no research on this. My RE has quite a bit of ancedotal evidence showing that there is success with this protocol, but where is the scientific evidence to back this up? More specifically, where is the scientific evidence of this that isn't written by Dr. Kliman himself, the founder of the EFT? Along with this line of questioning, the population that actually requires this treatment is so small, and, quite frankly, if you make it to this point in your journey, are you willing to sacrifice potential success by participating in a study where you may wind up with a placebo treatment, or in a control group? Likely not.

     Between this, my emerging anger over my situation, and the fact that I have no damn clue about what course of treatment to take, my therapist will be hearing an earful.

    To quote Vince Vaughn and Wedding Crashers -  "I'm gonna go see Dr. Finklestein and I'm gonna tell him we have a whole new bag of issues. We can forget about mom for a while."

IVF #3: Roundup

     To recap, this cycle started with a baseline of 3 follicles and an estrogen of 195. Then I had a mental breakdown. A few days later, I had 5 follicles and my estrogen of 196. So, not a great start.

     We did everything completely different for this cycle. I was on a MDLF protocol with prednisone (for high normal Th1/Th2 Cytokine Ratio). I took 10 units of micro-dose lupron AM & PM beginning 2/8 and added300 units of Gonal-F in the AM starting 2/10. We added in a vial of Menopur in the PM on 2/12 and continued with that. I then added 20 units of HGH (Omnitrope) for four nights beginning Thursday 2/18. So, by the end, I was up to 5 injections a day!

     My follicle count grew to 11, which is the most I have ever had during a cycle, and my estrogen on the day of trigger was 3116! I was so blown away by this because I had never had an estrogen at trigger higher than 1979! However, I know how this IVF shit works...nothing good happens without anything bad...and I said to my husband "watch, we'll get 5 eggs."

Guess what?

   We got 5 fucking eggs. Ok, that isn't the whole story. We actually retrieved 12 eggs. I was pretty uncomfortable towards the end so props to you PCOS girls who have 1023232 follicles. Although I still hate you bitches because you make it rain embryos. #sorrynotsorry. #Iamkidding. #kindof.

     Annnyyywwwaaayyy, of the 12 retrieved, 5 were mature and 5 looked like they could possibly mature in the lab. 2 did. So, that brought our total haul to 7. This is hilarious because we have wound up with 7 eggs every cycle! My ovaries are pre-set on a very specific number apparently.  This is also the first cycle we have done ICSI and 6 of our eggs fertilized normally!! This is the highest number of embryos we've ever had!!!

     If I'm being honest, I'm slightly disappointed. I was really hoping more would mature and fertilize. However, 6 embryos is a totally normal number to have for anyone, let alone someone with DOR. I just feel so much pressure to freeze several embryos because I'm about to go on 3 months of depot lupron, after which, the lupron will hang out in my system and keep my ovaries suppressed for several months so stimming again too soon will yield a shit cycle.

     We are culturing out the embryos to day 5, which is nothing short of terrifying. We've never done this before. I'm praying that this protocol shift, my supplements and HGH really kicked the quality of my eggs into high gear, and that ICSI helped us get the best sperm possible.

     Mostly though, I'm just hoping that somehow, someway, my future child is in there.
    

 

You too, uterus?!

Source

     For an entire year now, since the dawn of our time at the RE, I have sung my praises far and wide for my uterus. Specifically, my endometrial lining. My lining has been the shining star of my reproductive system. It builds up like a champ and reliably puffs up to its desired thickness like a deliciously tempting pastry, it develops a trilaminar appearance with ease, and has been complemented on by many a reproductive specialist.

     Recently, my uterus, as a whole, has been taken down a notch by the identification of a Narbothean cyst by Dr. KKs people, and by finding out that my uterine blood flow was less than stellar. However, the nail in the uterine coffin came when I received my EFT results.

     My lining has failed me and I need to enter a lupron-induced menopause for three months before my next transfer.

     Gone are the days of endometrial superiority. My lining can now retreat back to the Island Reproductive Organ Misfits with the rest of my lady parts. 

     According to Dr. Wang, we did the EFT due to my endometriosis diagnosis because studies have suggested that women with endo have a higher chance of having a dysfunctional endometrium, which can negatively impact the implantation process. My results showed the receptivity of my endometrium to be decreased. To explain it further, Dr. Wang said that the endometrium is largely composed of two components - the stroma and the glands. The stroma is like the scaffolding of a building that holds up a structure while the glands are the structures embedded within the stroma that are important in the implantation process. Basically, the stroma and glands harmonize in response to the hormonal changes throughout the menstrual cycle, which allows the endometrium to prepare for, and accept, the implanting embryo during the "window of implantation."

     From my EFT, it appears as if the glandular portion of the endometrium showed delays in development, which may affect its ability to allow the embryo to implant. This specific issue is called Glandular Developmental Arrest (GDA). This was determined during the EFT analysis when they went to look for a protein in the glands called cyclin E. Normally, cyclin E is present 5-6 days post ovulation, however, to prepare for implantation, the levels should drop low. High levels of cyclin E would suggests that my endometrium did not develop properly to allow for effective implantation. Normal cyclin E levels should be less than 20%, and ideally less than 10%. Mine came in at 30%. 

     High levels are normally caused by endo, hydrosaplinx and/or an endometrial infection. I've had enough things shoved up, around and into my vagina and uterus to rule out hydrosalpinx, and I have endo, so, yup. Therein lies the reason. 

     I also have high neutrophil levels which is indicative of an endometrial inflammation, which is also common in endo. 

     Naturally, I asked a few questions about this whole situation. I asked if my chemical pregnancy was a "good" sign and he said that it was, but that repeated chemicals are, in his experience, a common presentation of this lining problem. We can also treat for an endometrial infection but the possibility of that is low, and that, the success rates associated with the three months of lupron are exceedingly high. 

     So, that's that. We can now add my uterine lining to the list of fucked up reproductive pieces. For now, I'm hoping beyond hope that my oves yield a few good eggs (& embryos!) to transfer in May. So.Far.Away.